The 4 stages of endometriosis

Endometriosis is a medical condition in which the endometrial tissues which line up the uterus begin to over-grow and spread outside the uterus and implants in the surrounding places such as the fallopian tubes, ovaries, and other organs of the pelvic region. In case when the tissues grow normally inside the uterus, endometrial tissues shed off themselves, during each menstrual cycle, creating a monthly cycle. The endometrial tissues also shed off when implanted or attached to the organs outside the uterus, and the shedding can lead to inflammation, cysts, and scar tissue throughout the pelvic region, etc. Women with the condition of endometriosis may have symptoms such as chronic pelvic pain, pain during sexual intercourse, pain while urinating, gastrointestinal troubles, abnormal or heavy menstrual cycle, and infertility.

Stages are there of endometriosis

Endometriosis is medically categorized into 4 stages. Based on the diagnosis and what the gynaecologist identifies during a laparoscopic examination.  

  • Endometriosis Stage 1- Minimal Stage 

Stage 1 of endometriosis is considered minimal. In this initial stage, the implants are small in size, fewer in number, and shallow. Although it should be kept in mind that various stages of the endometriosis do not correspond to the pain and discomfort levels, the symptoms are generally more on that later stages of the condition. It means that just because a woman is having Stage 1 of endometriosis, it does not mean that she has minimal pain or that the other symptoms and side effects of the condition on her life are not severe.

  • Endometriosis Stage 2 – Mild Stage

 In Stage 2 of endometriosis, the complications and side effects are generally considered as mild. There might be more implants in this stage, which are also deeper than the superficial implants in Stage 1 of endometriosis.

  • Endometriosis Stage 3 – Moderate Stage

Stage 3 is considered as moderate endometriosis. There are many deep endometrial implants observed during this stage, but there can be an endometrial cyst on at least one of the ovary. The endometrial cysts are formed when the tissue lashes to an ovary and starts to shed blood and tissues. The blood is accumulated there and turns brown. For that reason, these over-growths are also known as chocolate cysts. Doctors may also find a thin band of tissue, called filmy adhesions, which joins organs together. The adhesions are the scar tissues that form when the body tries to heal after the inflammation caused by endometriosis. They can make organs join and stick together when they are not meant to be. These can cause severe, sharp and stabbing pain, nausea, in women suffering from endometriosis.

  • Endometriosis Stage 4 – Severe Stage  

Stage 4 is considered as a severe stage of endometriosis. Apart from multiple deep endometriosis implants, large cysts are present on at least one of the ovaries and many other dense adhesions throughout the pelvic area.

What do the stages of endometriosis mean?

female at gynaecologist

The increasing severity of the stages might deliver the impression that endometriosis, just like cancer, endometriosis starts off in one part of the body and then spreads to other distant organs. But endometriosis does not grow or spread like cancer. This disease can be widespread in nature right from the beginning.

The stages of endometriosis do not correlate to how severe or complex things such as infertility or chronic pain affect a woman with the condition. It also means that the stages do not necessarily give any suggestions on how to treat the condition for different females. Patients prefer to know how widespread the condition is in their case to know about the severity of the condition. There can be cases that a female with minimal to mild endometriosis experiences more pain than a female in a severe stage of endometriosis.

 Apart from that, a female with Stage 1 of endometriosis may be more infertile than a female with Stage 4 of endometriosis. The disease has different impacts on different patient’s lives and bodies. The disease is further divided into four different categories, depending on where the disease is located and it affects the patient:

  • Category 1: Peritoneal endometriosis 

In this, the endometriosis is located on the peritoneum membrane which lines the abdomen. Peritoneal endometriosis is the most minimal category. 

  • Category 2: Ovarian endometriomas 

In this case, endometriomas or cysts present in the ovaries, pose the risk of bursting or even spreading the endometriosis to other surrounding organs. 

  • Category 3: Deep infiltrating endometriosis 1 

In this case, the endometriosis is implanted in organs in the pelvic region, such as the ovaries, rectum, or the outside of the uterus. The patient may experience the condition of the frozen pelvis. In such circumstances, the scar tissue binds the organs together and impairs their normal function. 

  • Category 4: Deep infiltrating endometriosis 2 

In this case, the endometriosis is located outside the pelvic region and may also have implanted in distant organs such as the heart, lung, and brain. 

Also Read: What Is Endometrial Cancer?

Diagnosis of Endometriosis 


On an estimation, 1 in every 10 females has endometriosis. But it can take from  2 to 11 years for the condition to be diagnosed. In most cases, even the symptoms do not show up for quite a long time. The painful symptoms can be a result of a wide variety of other health conditions also. When the doctor suspects that the female has endometriosis, a laparoscopic diagnosis procedure is performed to confirm visually about the condition. 

During a laparoscopic diagnosis, the doctor makes a small incision in the abdomen of the female. A thin tube called a laparoscope is then inserted with a light and camera to diagnose the inside of the pelvic region. If they see symptoms of endometriosis, such as an implanted endometrial tissue or scar tissue, they can then diagnose the condition and remove those cysts and scar tissues.

Being able to diagnose the endometriosis implants and scarring is what allows the doctors to classify the disease into four different stages and then, categories. To detect the stage of endometriosis, the doctors give points to what they see while they perform the laparoscopy. The score of 15 or less indicates that on visually seeing, the disease is either on Stage 1 (minimal) or Stage 2 (mild). The score of 16 to 40 indicates that the disease is on Stage 3 (moderate), and the score of 40 or more suggests the disease at Stage 4 (severe).

The long term outlook of endometriosis can be improved if worked promptly with a gynaecologist. Get an appointment with the best gynaecologists in town at Pristyn Care. You can also speak to our gynaecologists online! 

Also Read: Tips to Cope with Endometriosis

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